Psychology and mental health

Spectrum of efficacy of valproate in 55 patients with rapid-cycling bipolar disorder

Article Abstract:

The most prominent characteristic of bipolar affective disorder is one or more manic episodes which alternate with one or more depressive episodes. Lithium therapy is the treatment of choice for this condition, but as many as 40 percent of bipolar patients do not respond to or tolerate this drug well. Previous studies have indicated that patients with rapid-cycling bipolar disorder represent a significant proportion of those who are resistant to this treatment. Carbamazepine has been used as a substitute and, although it has shown success with manic symptoms, it is not as effective in relieving the symptoms of depression. A second alternative treatment that has been suggested is valproate, and the efficacy of this drug in 55 bipolar patients was assessed. The subjects were all diagnosed with rapid-cycling bipolar disorder and had been resistant to other treatments. The patients were given valproate in combination with other drugs (35 subjects) or alone (20 subjects) and were followed over a period of about eight months. In the 20 patients receiving valproate alone, 89 percent exhibited a marked improvement during acute manic episodes, while only 57 percent showed a marked response during depressive episodes. The results confirmed previous studies that indicated valproate was effective in relieving manic symptoms, but had only a moderate effect on the symptoms of depression. The best method of treating depressive symptoms associated with this disorder is still not clear; more research is needed to determine whether a single drug or a combination therapy is the best approach. (Consumer Summary produced by Reliance Medical Information, Inc.)

A placebo-controlled, double-blind crossover study of fluoxetine in trichotillomania

Article Abstract:

Trichotillomania is a psychiatric disorder characterized by compulsive hair pulling. Because this disorder shows similarities to obsessive-compulsive disorder, drugs that are useful in treating obsessive-compulsive disorder have been suggested for use in treating trichotillomania. Fluoxetine, an antiobsessional agent, has been reported useful in treating the disorder in a few studies, but most of the studies involved open trials. To further examine the effectiveness of fluoxetine in treating hair pulling, a double-blind, placebo-controlled crossover study involving 21 adult chronic hair pullers was conducted. The subjects were given either fluoxetine or a placebo for six weeks, followed by five weeks of neither, and then six more weeks of the opposite substance. Fifteen subjects completed the study and one subject completed 16 weeks of the study before dropping out because of a drug reaction. Weekly ratings of hair pulling, urge to pull hair, number of hair pulling episodes, and amount of hair pulled per week were not significantly changed during either the fluoxetine or placebo treatment phases. These results indicated that with short-term use, fluoxetine is not effective in treating trichotillomania. (Consumer Summary produced by Reliance Medical Information, Inc.)